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Happiness: A Lens into the Therapist’s Struggle to Accept the Most Wounded Parts of Ourselves & our Patients
Male Sexual Abuse
Desire, Love & Attachment Styles
Building resilience for young Black boys through adaptive racial socialization
Early Contributors to British Object Relations Theory
Spring Lectures and Seminars
Oppression Monopoly- RESCHEDULED Date TBD
Research Proves Psychoanalysis Effective with Dr. Jonathan Shedler
Dewald Lecture 2023
Register for Spring Lectures and Seminars
On Marion Milner
Windows into the Therapy Process
Child Development Conference 2023
Cohn Lecture 2023: Age of Consent: Fetish, Kink & the Politics of Sexual Exploration
Something is Happening: Bob Dylan & the Psyche I
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About
Welcome to the Institute
What is Psychoanalysis?
Board of Directors
Join our Mailing List
Staff/Contact Us
Annual Report
Schiele Clinic
About the Clinic
$ Pay for Clinic Services
Sign up for Clinic Services
Faculty
2022 Retreat: Exploring APsaA Membership & Our Society/Institute Relationship
The K. Lynne Moritz, MD, Leadership Award
Faculty Directory
$ Pay Faculty Dues
Candidates and Advanced Candidates
Education & Training
$ Pay for Tuition
Analytic Training Programs
Training in Child and Adolescent Psychoanalysis
Training in Adult Psychoanalysis
Open Analytic Theory Classes
Child Adolescent/Adult Psychodynamic Psychotherapy Program
Child Adolescent Committee Courses
APP Alumni Resources
APP Teacher of the Year
Practicums, Internships & Fellowships
Schiele Clinic Training Programs
Clinic Training Interest Form
Research Fellowship
More Information Interest Form
Distance Learning
Scholarship Opportunities
Group Supervision
Professional Development
Lectures & Seminars
Community Education Speaker Form
Community Education Brochure 2022-23
Fall Lectures and Seminars
Register for Fall Courses
Happiness: A Lens into the Therapist’s Struggle to Accept the Most Wounded Parts of Ourselves & our Patients
Male Sexual Abuse
Desire, Love & Attachment Styles
Building resilience for young Black boys through adaptive racial socialization
Early Contributors to British Object Relations Theory
Spring Lectures and Seminars
Oppression Monopoly- RESCHEDULED Date TBD
Research Proves Psychoanalysis Effective with Dr. Jonathan Shedler
Dewald Lecture 2023
Register for Spring Lectures and Seminars
On Marion Milner
Windows into the Therapy Process
Child Development Conference 2023
Cohn Lecture 2023: Age of Consent: Fetish, Kink & the Politics of Sexual Exploration
Something is Happening: Bob Dylan & the Psyche I
Endowed Lectures
Continuing Education Credit Information
Distance Learning
Resources
Calendar
The Betty Golde Smith Library
Library Resources for Students
Articles & Podcasts
Watch Our Video Lectures
Read Our Psychoanalytic Perspectives
Giving & Support
Make a Donation or Tribute
Other Ways to Give
D.W. Winnicott Society
CA/APP Application
Home
CA/APP Application
CA/APP Application
Application for admission to the Child & Adolescent/ Adult Psychodynamic Psychotherapy program.
Please note: for all attachments requested for this application, please attach them in a separate e-mail to:
Recruitment
. If you are returned to a blank form upon hitting "submit," this indicates your form did not go through for processing -- please contact Recruitment at 314-361-7075 x 319 or e-mail
Recruitment
.
I am applying for
*
Child and Adolescent/ Adult Psychodynamic Psychotherapy Program (CA/APP)
Date:
*
I. CONTACT INFORMATION
Last Name:
*
First Name:
*
Middle:
Degree:
*
Preferred Name:
How do you prefer to be addressed? Please indicate the title we should use in our formal correspondence with you:
*
Dr.
Mr.
Mrs.
Ms.
Mx.
Other:
Home Address:
City, State, Zip:
Telephone:
*
Cell Phone
Email:
*
Enter Email
Confirm Email
Work:
Name of Institution:
Website:
City/State/Zip
Work Telephone:
Work E-mail:
Preferred communications:
Home
Work
Date of Birth:
Place of Birth:
Citizenship/Status:
II. ACADEMIC BACKGROUND
Name of Institution: Please add Dates, Location, Major and Degree
Additional Degree:
Additional Degree:
Special interests during your education:
III. EMPLOYMENT EXPERIENCE
Current Employment - Profession:
Place of Employment:
Position:
Length of Employment:
Description of what you do:
Previous Employment: Dates, Position and Experience
Additional Previous Employment: Dates, Position and Experience
Supervision, Consultation, Practicum or Volunteer Experience (that is relevant to this application):
IV. OTHER INFORMATION (If Applicable)
A. Awards, honors, publications or other demonstrations of merit (list):
Dates & Description
B. Personal therapy or Analysis: (The Institute totally respects the confidentiality of the therapist/patient relationship and will not in any way attempt to contact the therapist.)
Name of therapist
Frequency of Sessions
Dates From:
To:
V. REFERENCES
Please list two or more references. Your submission of this application form indicates that you give your permission for us to contact the names below.
Reference #1 Name / Address/ Telephone /E-mail
Reference #2 Name / Address/ Telephone /E-mail
Reference #3 Name / Address/ Telephone /E-mail
Additional Questions
VI. ADDITIONAL QUESTIONS
Please answer the following questions and e-mail questions to
Pamela Luttrell
, Programs & Services Manager.
All Applicants:
What are your goals in undertaking this program?
*
Briefly describe an incident in your work in which you were pleased with your efforts.
*
3. Briefly describe an incident in your current work in which you feel you did not do as well as you would have liked. What additional information or guidance would have helped you?
*
How would this program fit in with your professional objectives/plans over the next five years?
*
Describe your experience with psychotherapy or counseling.
*
VII. ADMINISTRATIVE INFORMATION
How did you hear about or find this program?
A. Do you intend to use this program for degree credit at an academic institution? Yes/No If yes, please describe your arrangement.
B. Do you anticipate needing to use video conferencing to attend classes/supervision?
*
Yes
No
C. Describe any special circumstances (financial concerns, scheduling or personal issues) that may affect or complicate your participation in this program:
Will a third party be paying any or all of your tuition?
*
Yes
No
Do you wish to apply for financial aid?
*
Yes
No
Please explain:
For Scholarship Consideration
*
Select All
I am submitting my course application along with a completed scholarship application to be considered for scholarships.
I will be mailing a copy of my tax return and financial need statement to: Pamela Luttrell, St. Louis Psychoanalytic Institute, 7700 Clayton Rd, Ste 200, St. Louis, MO 63117, or drop them off at our offices.
I understand that if I apply for financial aid, my application, tax return, statement of financial need and references will be assessed by the Financial Aid Committee.
CLICK HERE FOR NEED-BASED SCHOLARSHIP APPLICATION
VIII. SUBMISSION AGREEMENT
Terms of agreement - 1
*
I understand that my application and progress within this program will be subject to assessment by the instructors in the program and agree to abide by this assessment.
- 2
*
I also understand that this program is not being represented as training for practice in Psychoanalysis but as augmentation of existing theoretical knowledge and clinical skills in advanced psychoanalytically-oriented psychotherapy, for which specific recognition will be given upon graduation.
SIGNATURE _______________________________________________________________________ DATE__________________________________
There is a $75 application fee due at the time you submit your written application.
The application fee covers the processing of your application along with your applicant interview which will be scheduled for you in the near future.
Completed applications may be mailed with your application fee to:
St. Louis Psychoanalytic Institute, 7700 Clayton Rd, Ste 200, St. Louis, MO 63117.
Please enclose a check payable to the St. Louis Psychoanalytic Institute.
Please indicate your form of payment below:
*
I will mail in my payment.
I am processing an on-line payment.
Reminder:
For your application to be considered for financial aid, your completed application form, tax return, brief statement of financial need and references must be received by April 20th. Applications received later than April 20th will be considered by the Financial Aid Committee only if funds are available.
Application Fee. Note that the Tuition price is for ONE YEAR of the TWO-YEAR program. Tuition will be billed twice a year.
Price:
$75.00
Quantity:
Total
$0.00
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